Endocrine Flashcards
Onset, peak, duration for lispro, aspart, glusiline
Onset: rapid
peak: 1 hr
total: 4 hrs
Onset, peak, duration for regular insulin
Onset: 30 mins
peak: 1-2 hrs
total: 6 hrs
Onset, peak, duration for NPH
Onset: 1 hr
peak: 4-6
total: 16 hrs
Onset, peak, duration for Detemir
Onset: 1 hr
peak: 12 hr
total: 20 hr
Onset, peak, duration of glargine
onset: 1 hr
NO PEAK
duration: 24 hr
Effects of Metformin
inhibits glucose prodxn
sensitizes insulin receptors
reduces gut glucose absorption
Drug class/effect of Glipizide and glyburide
sulfonylureas, promote insulin release (NIDDM)
side effects for Glipizide and glyburide
hypoglycemia
weight gain
drug/effect Nateglinide and repaglinide
Meglitinides, promotes insulin release
side effects for Nateglinide and repaglinide
hypoglycemia risk (biggest risk with repaglinide), weight gain
drug class/effect pioglitazone and rosiglitazone
thiazolidinediones, decrease insulin resistance
side effects of thiazolidinediones
heart failure d/t fluid retention (caution with pre-existing)
Upper respiratory infection (URI), HA, sinusitis, myalgia
bladder cancer w/ long term, high dose therapy
can promote ovulation in women
Indication for thiazolidinediones
type 2 diabetes, often a an add on to metformin
drug class/effect of acarbose and miglitol
alpha-glucosidase inhibitors, decrease absorption of carbs from GI tract, lessened post-prandial glucose rise
side effects of alpha-glucosidase inhibitors
Gi discomfort
decreased iron absorption (anemia risk)
long term can lead to liver dysfunction
Effects of dipeptidyl peptidase-4 inhibitors (gliptins)
increase incretin hormones –> increase in glucose-dependent insulin release, decreased glucagon release after meals
DDP-4 inhibitors (gliptins) side effects
Rare: pancreatitis, fatal hemorrhagic or necrotizing
Hypersensitivity rxns: anaphylaxis, angioedema, stevens-johnson sydrome
hypoglycenmia only when mixed with other agents
Side effects of SGLT inhibitors
Female genital tract infexns
UTIs
increased urination –> hypotension, dehydration
Glucagon-like receptor agonists (GLP-1) effects
mimics effects of incretins, causing decreased postprandial glucose rise
adverse effects of GLP-1 agonists
GI side effects, pancreatitis (rare)
Effects of Mylin mimetic
synthetic analong of amylin, causing decreased gastric emptying, and suppression of glucagon (decreased post-prandial glucose rise)
adverse effects of Mylin mimetic
hypoglycemia when combined with other drugs, nausea, injection site rxns (mild)
Indication for glucagon
hypoglycemia when IV glucose is unavailable (and pt is unable to eat)
effects of glucagon
glycogen –> glucose, stimulates liver glucose prodxn. Also relaxes GI smooth muscle
Indication and effect of somatostatin analogs and growth hormone receptor antagonists
for excess growth hormone (giantism, acromegaly), pituitary adenoma,
inhibits growth hormone release
Somatotropin (exogenous) uses
pediatric GH deficiency
pediatric short stature (if more than 2 standard deviations below the mean)
prader willi syndrome (only if low GH)
adult GH deficiency
adverse effects of somatostatin
hyperglycemia (esp w/ DM)
cautions with glucocorticoids and somatostatins
glucocorticoids oppose the growth promoting effects of somatostatins
difference btwn cabergoline and bromocriptine
cabergoline is preferred bc the dosing is easier and it is better tolerated
difference btwn vasopressin and desmopressin
Vasopressin can cause stomach smooth muscle contraction (used post op for this reason). DDAVP is preferred bc it has a longer duration of action.
adverse effects of vasopressin and desmopresson
water intoxication (educate pt to drink less H2O)
Early s/s: drowsiness, confusion, HA
Late: seizures, comma
too high of a vasopressin dose can cause severe vasoconstriction, HTN, angina, MI
Hydrocortisone vs Dexamethasone vs Prednisone
hydrocortisone: identical to cortisol, glucocorticoid and mineral corticoid actions, PO (IV for stress dose), no AE @ physiologic lvl
Dexamethasone: high glucocorticoid activity, very little mineral corticoid actions
Prednisone: longer acting
Tx of ATCH/mineralocorticoid excess
can be from adrenal adenoma or adrenal hyperplasia
What is the use and effect of Levothyroxine
It is used for hypothyroidism, it is synthetic T4
AE of Levothyroxine
from too high dosing, hyperthyroidism
Indications for Liothyronine
inability/low ability to convert t4 to T3 (Liothyronine is T3)
Myxedema coma
Why is Liothyronine rarely used?
- Shorter ½ life
- 4x as potent = higher risk of adverse effects Unnecessary: T4 (prodrug) to T3 peripherally
Methimazole vs PTU
Methimazole has a longer half-life, it is more potent (lower dose req), and serious side effects are less common, but there is a risk of the fetus developing hypothyroidism in the first trimester (not making own t3/T4 yet). PTU is preferred in a thyroid storm bc it prevents the conversion of T4 to T3 peripherally
Non-radioactive iodine (lugol solution), effects
-Inhibits T4/T3 synthesis + T4/T3 systemic release - -Rapid effect, but temporary: when concentrations normalize, T3/T4 will increase (temporary tx
exogenous estrogen indications
- Menopausal hormone therapy (HT)
- Female hypogonadism
- Acne
- CA palliation
- Gender affirmation therapy for transgender women
- contraceptive
Exogenous progesterone indications
-Menopausal hormone therapy (HT)
- Dysfunctional uterine bleeding or amenorrhea (withdrawal bleeding)
- Infertility
- Premature delivery prevention
- Endometrial hyperplasia (preCA) & carcinoma (palliation)
Drug class and differences btwn Tamoxifen, Raloxifene, Bazedoxifene
Drug class: SERMs
Tamoxifen can result in endometrial cancer. Tamoxifen and Raloxifene can be used to prevent cancer. Raloxifene and Bazedoxifene can be used to prevent osteoporosis. Only Bazedoxifene can be used to treat vasomotor symptoms.
How do a transdermal birth control patch and the vaginal contraceptive ring work?
It works the same as oral birth control by inhibiting ovulation and thickening cervical mucus. Vaginal contraceptive ring can also cause some local irritation
How does the subdermal etonogestrel implant work?
It lasts for 3-5 years and has only progesterone, can cause some irregular vaginal bleeding
What is Depot medroxyprogesterone acetate? How does it work? Warnings?
Birth control given by IM or sub q injection, works by inhibiting FSH/LH secretion. It can cause bone loss, so it is not recommended for more than 2 yrs
Copper IUD vs levonorgestrel IUD
Both IUDs work by creating local inflammation. The copper IUD can be used as emergency contraception up to 5 days after fertilization), and can last for up to 10 yrs. levonorgestrel is a hormonal IUD that thickens cervical mucus, inhibits ovulation and alters the endometrium
emergency contraceptives
progestin only: decreases pregnancy btwn 84-89%, will not terminate existing pregnancies or harm fetus, adverse effects of heavy bleeding, or GI upset
Progestin agonist/antagonist or copper IUD can be used up to 5 days after fertilization
adverse effects of mifepristone with misoprostol
abdominal pain, heavy bleeding, bacterial infection
contraindications of mifepristone with misoprostol
ectopic pregnancy, hemorrhagic disorders, anti-coagulant use
adverse effects of Clomiphene
hot flashes, bloating, breast engorgement, Rare: ovarian hyperstimulation
How do Follitropins work?
exogenous FSH that acts on ovary
how hCG and choriogonadotropin alfa work. What are AE
acts on ovary to induce ovulation. AE: ovarian hyperstimulation syndrome, rupture of ovarian cysts
Uses of Ergot Alkloid derivatives, drugs, adverse rxns
cabergoline and bromocriptine can correct amenorrhea and infertility caused by excessive prolactin prodxn (works by activating dopamine receptors).
Adverse effects: HA, nausea, dizziness
what drug class is nifedipine? How does it work? What are adverse effects?
nifedipine is a calcium channel blocker, which helps decrease uterine contraction.
AE:
Tachycardia
facial flushing
HA
Dizziness
Nausea
AE of Hydroxyprofesterase caproate
injxn site rxns, nausea, hives, diarrhea
v rare: thrombosis/thromboembolism – avoid in those w/ Hx
glucose intollerance
What class are Dinoprostone and Misoprostol? What are major AE? How are they different?
Prostaglandins,
AE: tachysystole, systemic absorption can cause N/V, diarrhea, fever
Dinoprostone is administered as a gel or vaginal pouch, Misoprostol more effective, cheaper, higher tachysystole
Contraindications to oxytocin (pitocin)
Cephalopelvic disproportion
placental abnormalities
fetal distress
AE of oxytocin (pitocin)
shivering
temp elevation
AE of Misoprostol
N/V, diarrhea, shivering, temp elevation
Contraindications of methylergonovine/methergine
avoid in HTN
caution with CV, renal and liver d.
What is Testosterone enanthate used for?
testosterone replacemtn therapy (goal is physiologic norm). Improves libido, sex characteristics (NOT fertility)
What is Testosterone cypionate used for?
male hypogonadism, and testosterone replacement therapy
What class is Methyltestosterone? What are its adverse effect? What is it used for
17-alpha-alkylated compounds (Hepatotoxicity). Use for Delayed puberty
Difference btwn Sildenafil, Vardenafil, Tadalafil
and Avanafil
Sidenafil is preferred. Vardenafil prolongs QT, Tadenafil long lasting 36 hrs, and can be used for BPH as well by relaxing the prostate
Avanafil fastest onset
How does Alprostadil work? How is it administered? AE?
injection into the penis or urethra, causes vasodilation. AE: dull penis aching, urethral burning, spotting
How does Papaverine + phentolamine work? What are AE?
vasodilator + alpha blocker, increased arteriole inflow, decreased outflow –> erection.
AE: priapism, orthostatic hypotension, dizziness, transient paresthesias, difficulty with achieving orgasm
especially helpful when ED from neuro/vascular origin
What classes are Finateride and Dutasteride?
5 alpha reductase inhibitors
Dutasteride completely reduces DHT, has a long half life (5-weeks), takes months to clear drugs
What class are Silodosin, Tamsulosin, Doxazosin
and terazosin? How are they different from each other
They are alpha 1 adrenergic antagonists used for BPH. Silodosin and Tamsulosin are alpha 1 selective, while doxazosin and terazosin are nonselective. The selective ones can lead to abnormal ejaculation
